Marginal Zone Lymphoma (MZL)

MZL is a slow-growing lymphoma, which makes it difficult to self-detect the condition in the early stages. Make sure to speak to your doctor as soon as you notice any changes in your health, as it could help detect MZL or other conditions early and make a significant difference in your prognosis.

Every type of MZL comes with different symptoms:

MALT

Persistent indigestions or heartburn, stomach aches, nausea and loss of appetite⁸ can be signs of gastric MALT. If the cancerous cells are located in other areas, it can be difficult to self-detect your condition, as many people with non-gastric MALT are asymptomatic. Often, non-gastric MALT is found during routine check-ups or tests for other conditions.⁹ Doctors will diagnose MALT by taking a biopsy from the affected area. If the cancer is located in your stomach, they will also perform an endoscopy to get a clear idea of the progression of the disease.

NMZL

Painless and hard lumps in the neck, armpit or groin that don’t go away are common indicators of NMZL due to the lymph nodes swelling.¹⁰ To reach a conclusive diagnosis, your doctor will perform a biopsy by removing part of an enlarged lymph node that will then be examined for cancerous cells.¹⁰

SMZL

As people with SMZL are largely asymptomatic, the condition is often detected during abdomen checks or blood tests. In later stages, the spleen can enlarge due to lymphoma cells building up, causing pain in the upper abdomen. An enlarged spleen can also cause blood cells to be removed from the blood, which can make you feel very tired and out of breath.^[7]

To detect SMZL, your doctor will most likely conduct blood tests or a bone marrow biopsy.¹¹

Due to the rarity of MZL, clinical trials are limited compared to more common cancers, making it difficult to identify treatments with the best outcome.¹⁴

Because of the slow-growing nature of MZL, ‘watch and wait’ is often adopted for all three types. This means that doctors will monitor the progression of your condition and not prescribe treatment unless your symptoms worsen, as there is no evidence that early intervention would favour your condition.¹³

If treatment is needed, a team of multidisciplinary specialists will help you decide on a treatment plan based on the progression of the disease, your overall health and how your symptoms are affecting you. For all three types of MZL, your doctor could advise:^[7]

• Chemotherapy, sometimes in combination with steroids to make the therapy more effective
• Radiotherapy
• Targeted therapy

If you have early-stage gastric MALT, you could benefit from antibiotic treatments. MALT is often paired with Helicobacter pylori, a bacterium that causes damage to the stomach and that can be targeted with antibiotics to shrink the lymphoma.¹⁵

It’s normal to feel uncertain about deciding on the best treatment plan for you, especially when there’s no consensus on the most optimal treatment for MZL. Make sure to ask your doctor as many questions as possible, and don’t hesitate to speak to several specialists to better understand your options.

The list below includes example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.

• Which type of MZL do I have and what can I expect?
• What are my treatment options? How much time do I have to decide?
• How long will the treatment take?
• What are the possible side effects? How can I manage them?
• What side effects should I tell you about right away?
• What happens if the treatment doesn’t work?
• How will this affect my everyday life?
• Can I get a second opinion? Are there any specialists I can speak to?
• Are there any clinical trials I can join? How effective are they?
• Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed or distressed? Can I be referred to patient support groups?
• …